Individual health insurance data of antibiotic delivery in previous months as a tool to predict bacterial resistance of urinary tract infection: A prospective cohort study - 31/08/24
, André Gillibert b, Sandrine Dahyot c, Roland Fabre d, Francis Kuhn e, Jacques Benichou f, Valérie Delbos a, François Caron aHighlights |
• | E. coli resistance is partially linked to previous personal antibiotic delivery. |
• | FQ and TMP-SMX showed a high impact on risk of subsequent AMR E. coli. |
• | Fosfomycin use is not associated with high risk of AMR E. coli causing UTI. |
Abstract |
Objectives |
We aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months.
Patients and methods |
French patients were prospectively recruited in two centers in 2015–2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files.
Results |
Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20–2.21], 1.59 [1.02–2.48], 3.01 [1.90–4.77], and 2.60 [1.75–3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41–1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]).
Conclusions |
Resistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery.
Le texte complet de cet article est disponible en PDF.Keywords : Urinary tract infection, Escherichia coli, Antimicrobial resistance, Fluroquinolones, Antibiotic exposure
Plan
Vol 54 - N° 6
Article 104942- septembre 2024 Retour au numéro
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